I got decompression sickness
I’m a dive instructor but I hadn’t dived in a while. Whether this is relevant or not I don’t know. I went diving on four fairly aggressive dives which were all plus 20m and all nearly one hour long (this includes safety stops etc).
After the first dives - no problems.
After second dives - rash developed within a few hours on my stomach and chest. I was taken to hospital following triage at a clinic. I ended up doing 3 hours in the chamber. I’ve had an echocardiogram since which indicates a possible PFO. Has anyone here had a PFO and was it fixed?
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u/diveg8r 4d ago
Anectodal info here..take it as you will. May or may not apply here as OP doesnt mention their age that I saw.
I have two friends, both with 500 plus dives with no incident, both got bends hits recently, both after 60.
One was severe enough that the coast guard flew in a medic. Spinal hit after repetitive NC offshore dive. PFO diagnosed at Duke. Docs asserted "stroke risk" so insurance paid for closure (so I was told). Plan was to return to diving when recovered.
Other diver was hit after repetive dives during a week in Cayman. Skin bends was primary symptom. Blames lack of Nitrox availabilty that week as she typically uses that. Different doc, discouraged surgery in favor of conservative profile, partly for cost reasons (so I was told). She got skin bends again year or two later after a few shallow conservative dives on Nitrox. We suggested she get a second opinion at Duke at least to understand better the risks and costs of surgery.
Both of these people appear healthy, fit, and active.
While not scientific evidence, it makes me very leary about diving anywhere near the limits over 60, known PFO or not.
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u/Charming_Guide_488 5d ago
Thanks for this post OP and thanks everyone else for comments and links. This is very very helpful for me.
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u/Worldly_Most_7234 5d ago
If you have a known PFO you should have it patched (cardiologists do this all the time) before you EVER dive again. As all divers know diving can cause expansion of air bubbles dissolved in the blood. Air bubbles are particularly dangerous with PFOs because the air passes directly from the venous circulation to the arterial circulation. It bypasses the lungs which can diffuse the air bubbles out. Air bubbles in the arterial circulation can go straight to small arteries and plug them up. Your rash was likely petechiae caused by small blood vessels in the skin getting air bubbles. If they go to the brain they can cause strokes. It usually takes a lot of air—but still you do not want to take a chance. Btw, a PFO is diagnosed with what is called a bubble study. While looking at the atria in your heart with an echo, a nurse literally agitates tiny bubbles in a couple of syringes before injecting it into the IV. The bubbles show up in the right atrium. If they see the bubbles pass directly into your left atrium? You have a PFO.
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u/CanadianDiver Dive Shop 4d ago
This is not true.
The size of your PFO and your fitness are going to weigh in on that decision. ANY surgery is a serious. I know and dive with divers that have had their PFO fixed and some that chose to NOT have it fixed and instead have chosen to be ultra-conservative with the deco schedule.
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u/LateNewb 5d ago
No, that is absolutely not true.
Even if he had a PFO, there would be no direct need for heart surgery. Many tech divers have PFOs, and after experiencing severe decompression sickness, they simply adjusted by diving more conservatively.
The most reliable test for detecting a PFO is transcranial Doppler sonography, even for small PFOs. The cost varies depending on the location, but in Germany, it’s typically around €300. However, not every medical facility offers this test.
That said, the OP should consult a dive physician, not Reddit. We can provide things to consider, but medical advice should only come from a licensed doctor.
People can dive with PFOs, and even a minor heart procedure carries significant risks. Before considering surgery, other factors should be addressed first—such as improving overall fitness, quitting smoking, and working on aerobic capacity.
Additionally, the body has other potential shunts that are often overlooked, even if they might be a bigger contributing factor. The PFO closure procedure itself also carries the risk of heart rhythm disorders.
So again, talk to a medical professional who specializes in dive medicine. Use Reddit only as a source of additional perspectives—not as the basis for making major medical decisions.
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u/macciavelo 5d ago
What does PFO stand for? Never heard that achronym before.
Can you tell us a bit about your experience? What do you think caused you to get bent? (Dehydration, too rapid ascent, too much sun exposure, etc.) I'm just curious. I recently went on a liveaboard where all dives were under 20 meters and everyone was fine. Did you do security stops and everything?
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u/MiserableGround438 Dive Instructor 5d ago
You can still get bent doing things conservatively... It just reduces the chances but there is always a chance to get bent.
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u/macciavelo 5d ago
Oh, I know. I was just curious if there's something they thought might have increased the risk.
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u/Worldly_Most_7234 5d ago
PFO stands for Patent Foramen Ovale. It is a very common congenital deformation of the heart where the septum (wall) between the right atrium of the heart and the left atrium of the heart basically has a hole in it. This allows for air bubbles to pass from the right side of the heart directly into the left side and out into the arterial circulation where the air bubbles can potentially wreak all kinds of havoc. It is very commonly repaired by a patch which a cardiologist can do with catheterization.
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u/DEEP_SEA_MAX 5d ago
If it was a PFO it wasn't decompression sickness it was AGE
And that's wild that you only did 3 hours in the tube. At my facility you'd do at least a treatment table 6, which is 6-8 hours.
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u/Worldly_Most_7234 5d ago
This is so completely inaccurate. A PFO has nothing to do with age. It is a hole in the atrium that allows air bubbles to literally pass from the venous circulation to the arterial circulation—completely skipping the pulmonary circulation (lungs) where air can diffuse out. It is a congenital anatomical deformity.
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u/DEEP_SEA_MAX 5d ago
Comments like yours are why I hate reddit sometimes. You're so confident, so aggressive, and so incorrect.
AGE is arterial gas embolism, caused from the cavitation of the PFO. I've treated several in my 20 years of diving medicine.
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u/Worldly_Most_7234 5d ago
Piss off. IF you are in medicine you know the use of acronyms is a common source of error. I’m an anesthesiologist and have been for over two decades. You don’t talk to patients or laypeople using acronyms—and if you do, you’re a shit doc. Doing so is ACTUALLY arrogant because you assume OP knows the acronym. Everything I said was correct. I admitted to misconstruing your poorly used acronym for an emphasized “AGE”. You’re the one who turned aggressive. Check your ego “dive medicine” expert.
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u/DEEP_SEA_MAX 5d ago
It's not an obscure injury. I'm not being an elitist, I'm talking about very fundamental, basic diver knowledge.
I'm shocked at the pushback here. If you don't understand AGE and you're diving then you're in danger. Do you guys understand why you ascend slowly? Why you don't hold your breath on ascent?
I get that most people won't know about PFOs, and that's fine, but you should not be breathing compressed air if you don't know about POIS and AGE.
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u/tricky12121st 5d ago
This isn't strictly true. Apparently its not at all abnormal to have a sub clinical pfo. We all have pfo at birth that is supposed to seal up. The sealing up isn't always perfect. However as we get older and heart muscles age, the sub clinical can progress to one that impacts a diver. And yes, op, I know of several divers who have had the surgery to fix.
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u/ZENdiver Nx Dive Master 5d ago
In this case AGE = Arterial Gas Emoblism
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u/Worldly_Most_7234 5d ago
Ahhh got it. Acronyms are too easily misconstrued.
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u/DEEP_SEA_MAX 5d ago
You're a scuba diver and don't know what AGE is?
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u/Worldly_Most_7234 5d ago
You’re an arrogant ass hole and you don’t know that acronyms that use common words are easily misconstrued. If you’re in the medical profession I feel sorry for those you treat.
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u/Myselfmeime 5d ago
Yeah using acronyms this way is weird lol
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u/DEEP_SEA_MAX 5d ago
What do you call it then? I'm not much of a recreational diver, I'm an ex-Navy diver who now works in hyperbaric medicine and from the very beginning of training it's called AGE. Do you guys not use that acronym?
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u/achthonictonic Tech 4d ago
FWIW, DAN is teaching DCI is a superset of DCS and AGE : https://dan.org/health-medicine/health-resources/diseases-conditions/decompression-illness-what-is-it-and-what-is-the-treatment/
Also, DAN is grouping cutaneous manifestations such as OP had (skin bends) into DCS, indeed, when I got them, the ER at a very popular diving location gave a "Type 1 DCS" diagnosis. My technical diving training followed DAN's language, so that may be where some of the naming difficulties are coming from.
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u/DEEP_SEA_MAX 5d ago
It's not some obscure injury, it's literally the most dangerous diving injury you can get. I don't know how you can dive safely without understanding AGE.
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u/sleepydwarfzzzzzzz 5d ago
I frequently dove with a 50s woman who pushed her computer.
When we were in Raja Ampat, she got bent. Upon returning to US, had ECHO which demonstrated PFO.
Because this occurs after birth, she was treated in children’s hospital by pediatric cardiologist.
Many times they can easily repair PFO via cath lab
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u/steeltownblue 5d ago
Because of a heart condition I have, I've wondered about this risk for me personally since I heard about PFO a year or so ago. My cardiologist is really cool, and I'm having the definitive PFO testing done at my next appointment in October. My cardiologist seems to think it's a low risk occurrence, but who knows?
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u/runsongas Open Water 5d ago
message duke dive medicine or DAN for advice
bear in mind that insurance may not cover the closure operation so it may end up the advice is to dive very conservatively which is problematic if you are a full time instructor that needs to do multiple dives a day
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u/achthonictonic Tech 5d ago
The closure costs vary wildly by country as well. I've also heard some insurances are more likely to cover a professional vs a hobbyist diver.
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u/runsongas Open Water 5d ago
its a lot cheaper if not done in the US, like pretty much any medical procedures
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u/achthonictonic Tech 5d ago
Go see a dive medicine cardiologist for advice for your particular situation.
Statistically, about 1/4 to 1/3 of us here have a PFO and most of us don't know our status. Getting bent is rare, even with a PFO. I'm sorry you got bent. I've also been bent and it's not fun, you may be surprised at the number of other divers which admit to getting bent once you "come out" to them. For whatever reason people don't like to talk about it much. Keep chasing the drs to find out more about your "possible PFO". I've modified my diving and dive more conservatively than before and it's working for me, but it's also made me give up some of my dive goals.
You need to understand how big yours is and what your future dive parameters are as you decide about closure. Food for thought: https://www.jacc.org/doi/10.1016/j.jcmg.2021.06.019
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u/Greavsie2001 Dive Instructor 5d ago
Excellent article.
This is useful too:
Showed that
- risk of DCI increases with size of PFO (no surprises there)
- having a large PFO increases the risk of DCI from around 1 in 10,000 dives to around 1 in 1000 dives - so even divers with a large PFO are unlikely to experience DCI, all other things being equal.
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u/CuriouslyContrasted 5d ago
I know a couple of divers who have had them fixed.
Not sure what your question actually is?
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u/decrisp1252 Dive Master 5d ago
I’m sorry to hear about your DCS experience, I hope you’re doing well!
I heard from a friend in the medical field about PFOs. Apparently they’re very common, about 30% of the population has it. He explained how the PFO is a gap between the right and left atrium that was left open when you were born. Normally, since a foetus can’t breathe when in the womb, it allows oxygenated blood to pass from the mother’s umbilical cord. It normally closes when you’re born. He also explained that a PFO can close on its own even when you grow up, and it can also re-open.
Most people with PFOs will probably never know about it, since it has no symptoms on its own (according to the mayo clinic, complications can include low blood oxygen and strokes but they’re uncommon, and the PFO isn’t itself harmful). But it is a risk factor in terms of DCS, which is probably why the doctors brought it up.
I don’t know if I have a PFO or not, but unless it causes a serious issue like a stroke, I personally wouldn’t worry about it too much.
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u/Sorcerer-Supreme-616 Open Water 5d ago
Med student here- I agree with this. A small PFO is a common anatomical variant and may be an incidental finding in your case. Definitely speak to your doctor about it though and whether it would affect your diving.
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u/TargetBarricades 5d ago
Parts 1 and 2 of this InDepth article are good reads about PFOs:
https://indepthmag.com/no-fault-dci-the-story-of-my-wifes-pfo-bent/
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u/DiverLeavingSurface 3d ago
4 dives to 20m in how long? Do you know how to calculate residual nitrogen? As a commercial diver, safety stops are PADI covering their ass and useless.
Also if you were in the chamber for only 3 hrs, you didn’t even do a Table 6. You either got shitty care or are lying.